The role of healthcare organizations in activating self-care systems and responding to emergency situations

International Journal of Medical, Pharmacy and Drug Research (IJMPD)
[Vol-4, Issue-4, Jul-Aug, 2020]
ISSN: 2456-8015
https://dx.doi.org/10.22161/ijmpd.4.4.1
www.aipublications.com Page | 24
The role of healthcare organizations in
activating self-care systems and responding to
emergency situations
Prof. Hatice Bebiş1
, Qasim Azeez Ali2
1
Health Sciences Institute, Near East University, Nicosia, Turkey
2
MSc student of public health, Health Sciences Institute, Near East University, Nicosia, Turkey
Email: kasm_zh@yahoo.com
Abstract— Background: Self-care refers to the individuals’ ability to promote and maintain their health.
The first requirement for self-care is raising awareness of healthcare issues. In this regard, healthcare non-
governmental organizations can play a significant role. The present study was carried out in order to
investigate the role of an active health organization in the Kurdistan Region of Iraq in activating self-care
practices and responding to emergency situations.
Methods: The study was a descriptive qualitative one that was carried out from July to December 2019 on
16 participants who were selected from doctors, nurses, managers, social researchers, employees, and
patients in Zhian health organization. Unstructured in-depth interviews were carried out to collect
required data. The collected data were analyzed through van Manen’s method, and the relevant themes and
subthemes were extracted.
Results: Analyzing the collected data led to emergence of two main theme which were labeled as “raising
health awareness” and “providing emergency health care”. The first main theme had three subtheme,
namely “raising public awareness of self-care”, “raising the pregnant women’s awareness of self-care”,
and “raising the women’s awareness of gender-based violence”. The second main theme had two
subtheme, namely “providing refugees with emergency health care” and “providing internally displaced
persons with emergency health care”.
Conclusion: Primary healthcare NGOs can play a significant role in raising health awareness, promoting
self-care activities, and providing emergency health care. As a result, such NGOs need to be developed and
supported by the government and the Ministry of Health.
Keywords— healthcare organizations, self-care, emergency situations, qualitative study.
I. INTRODUCTION
According to the World Health Organization, self-care is
“the ability of individuals, families, and communities to
promote health, prevent disease, maintain health, and cope
with illness and disability with or without the support of a
health-care provider”. Self-care is highly significant for
individuals particularly in low-resource settings such as
natural disasters and wars where it is quite challenging to
have access to professional medical care. Healthcare
systems can also benefit from self-care, such as decreasing
the level of burden on the healthcare providers and
improving health coverage [1,2]. On the other hand, an
emergency is a situation that causes health, life, property,
or the environment to undergo some levels of risk.
Healthcare non-governmental organizations (NGOs) are
primarily aimed at providing healthcare and rehabilitation
services, and most of them work on health development
and emergency response [3].
Self-care can include a set of activities and capacities. It
can be taken into account from two complementary
dimensions; one aims to improve the capacity of
individuals to self-care and the other one is related to the
relationship between self-care and the health system:
people-centered and system-centered [4]. The individual’s

ISSN: 2456-8015
capacity and ability to make wise health decisions and use
the available health resources is a significant element of
effective management and prevention of a health condition.
The capacity to reach and utilize familial and societal
resources plays a role in personal agency and autonomy
and specifies health outcomes [5].
It is vitally important that healthcare organizations develop
an emergency management program to support the
development and maintenance of critical emergency
operations components such as the emergency operations
plan, training and exercises, and collaborative
relationships. Healthcare organizations must monitor and
update their emergency operation plans on an ongoing
basis, maintaining a constant state of preparedness to
ensure appropriate response and recovery within the
shortest possible time frames [6]. Without proper planning,
an incident involving the organization may result in either
a temporary or permanent failure, thus disabling a crucial
community resource. The emergency operations plan also
should be fully integrated with that of other organizations
and appropriate agencies at the local, state, regional and
national levels. This is particularly important in situations
such as a pandemic that may simultaneously impact large
geographic areas for several months and disrupt national
and international supply chains [7]. Moreover, emergency
situations that can have negative effects of public health
are increased by different factors such as behavior, beliefs,
healthcare services, socio-economic environment,
population profile, physical environment, and political
context [8].
Since the overthrow of Saddam in 2003 and later the
invasion of ISIS in 2014, there has been an increase in
emergency situations in Iraq and the Kurdistan Region of
Iraq. The swarm of internally displaced people (IDPs) and
refugees particularly to the Kurdistan Region due to its
relative stability compared to other parts of Iraq has also
added to emergency situations. There have also been some
natural disasters like earthquake and floods in the region
recently, which has worsened the emergency situation [9].
Therefore, healthcare NGOs need to adopt appropriate
measures to handle emergency situations in the region.
Self-care interventions for health have been introduced as
the most promising new approaches contributing to
universal health coverage (UHC) particularly in emergency
situations (WHO, 2019). It is the responsibility of the
healthcare system and the related organizations (both
NGOs and public entities) to establish a self-care system
and boost self-care practices among the public, so the
people know how to survive in disasters and emergencies
[9,10].
Since self-care can promote and improve wellbeing and
health, it is a significant element of people-centered care
[1]. A people-centered care system puts emphasis on self-
fulfillment, empowerment, and psychological needs,
placing less emphasis on technical activities and instead
looking at self-care in terms of capacities, building on a
person’s “health assets,” both as a condition for and a
product of the practice of self-care [1,10, 11]. So far, there
have been no established self-care practices in Iraqi
Kurdistan, resulting in an increased rate of casualties and
loss in case of healthcare emergencies. In this regard, the
present study was carried out in order to investigate the
role of Zhian health organization which is an active
healthcare organization in the Kurdistan Region of Iraq in
activating self-care practices and responding to emergency
situations based on the lived experiences of those who have
worked in or received healthcare services from Zhian
health organization.
II. METHODS
Study design and setting
The present descriptive qualitative study was carried out
using a hermeneutic phenomenological design. It was
conducted in Zhian health organization primary health care
(PHC) Camp located in Erbil city of Kurdistan Region of
Iraq over a period of 6 months from Julyto December
2019.
Participants: The study sample consisted of 16 participants
who were doctors (n=8), nurses (n=1), manager of gender-
based violence (GBV) manager (n=1), social researchers
(n=1), and employees (n=1) who were working in Zhian
health organization primary health care (PHC) Camp and
provided the patients in the camp with health care. The
study also included patients, refugees, and patients (n=4) in
the study. They were chosen by a purposive sampling
method.
Data collection: Unstructured in-depth face-to-face
interviews were conducted with the participants in order to
collect required data. Data collection was continued until
data redundancy occurred. The interviews were conducted
in the participants’ desired place and time. Following the
participants’ consent, the interviews were tape-recorded
and transcribed verbatim. The scripts of the interviews
were translated into English line by line and word by word
by a highly experienced native-like translator and were
analyzed according to Van Manen’s method (1990), so that
the researcher’s interpretation will be possible. For data
collection, the following interview questions were asked.

ISSN: 2456-8015
“Please tell me about your feelings and lived experience of
the role of active healthcare NGOs in Iraqi Kurdistan in
activation self-care systems and responding to emergency
situations?” Other questions were directly given to the
participants to encourage them to continue reflecting on
their past experiences. They included, “Please tell me
more”, “Can you give an example?”, “How did you
feel/think about that”, “What was it like?”, and “You said
that . . . .?” The researcher remained “silent” as a tactful
way to encourage the participants to recall and tell their
experiences.
Data analysis: Data analysis was carried out through the
six methodological steps proposed by van Manen’s method
(1990). The hermeneutic approach proposed by van Manen
is used to reach a high level of abstraction [13]. As a result,
van Manen’s method (1990) was used to analyze the
collected data. This method consists of 6 methodological
steps, including turning to the nature of lived experience,
investigating experience as we live it, reflecting on the
essential themes which characterize the phenomenon,
describing the phenomenon in the art of writing and
rewriting, maintaining a strong and orientated relation to
the phenomenon, and balancing the research context by
considering the parts and the whole [14].
Trustworthiness: To make sue about and maintain the
rigor of the study, four operational techniques, namely
credibility, transferability, dependability, and
confirmability were used [15]. In addition to this, there was
a prolonged engagement with the data over a period of 2
months during which the researcher referred to Zhian
health organization primary health care Camp located in
Erbil, had effective communication with the participants,
and employed the member- and peer-checking techniques
in order to make sure about the credibility of the findings
[16]. Furthermore, given the fact that the researcher is a
master’s candidate in nursing and has experience in terms
of providing health care to patients, his credibility was also
achieved.
Ethical considerations: The ethical considerations were
taken into consideration through the approval obtained
from the Ethics Committee of Near East University. Also,
before the final participants were selected and the
interviews were conducted,the participants were provided
with sufficient explanation about the aim of the study and
the data collection method. Moreover,a written informed
consent form was filled by each participant. The
participants’ information was kept confidential and
anonymous bylabelling them as Participant No. 1,
Participant No. 2, etc.
III. RESULTS
Analyzing the data obtained from the participants led to
interpreting the role of Zhian health organization
healthcare organization in activating self-care practices and
responding to emergency situations as two main themes,
namely “raising health awareness” and “providing
emergency health care”. The first main theme had two
subthemes, namely “raising public awareness of self-care”,
“raising the pregnant women’s awareness of self-care”, and
“raising the women’s awareness of gender-based
violence”. The second main theme also had two
subthemes, namely “providing refugees with emergency
health care” and “providing internally displaced persons
with emergency health care”.
First main theme: Raising health awareness
Analyzing the scripts of the interviews revealed that Zhian
health organization primary healthcare organization has
been successful in raising health awareness among its
clients, resulting in activation of self-care activities and
practices among them. In this regard Participant No. 10
stated, “One of the main goals of Zhian health organization
is to enhance people’s awareness of health by training
them and providing them with required knowledge on
medical issues.” The same fact was referred to by
Participant No. 5 who was an Arab IDP as she stated,
“After receiving medical services from Zhian health
organization, I’m now more aware of my and my child’s
medical issues.” Data analysis indicated that rising health
awareness in Zhian Health Organization had a particular
focus on the public self-care, pregnant women’s self-care,
and gender-based violence, which were labelled as three
subthemes of the first main theme.
First subtheme: Raising public awareness of self-care
Raising awareness of health care was referred to as one of
the fields in which Zhian health organization has been
successful in. In the long run, this goal gives way to
elevated public awareness of self-care. In this regard,
Participant No. 8 who was a nurse working in the
organization said, “I’ve noticed that most of our regular
clients and those we pay visits tent to tent are much more
careful about their health than before. They pay more
attention to what they eat and are sensitive about their
regular check-ups.” Moreover, Participant No. 9 who was
a Syrian refugee revealed, “Doctors and nurses of Zhian
health organization give us regular educational classes and
teach us how to take care of our and our family’s health. I
feel that we’ve got a far healthier lifestyle than before.”

ISSN: 2456-8015
Second subtheme: Raising the pregnant women’
awareness of self-care
One of the main objectives of Zhian health organization
Care Organization which was highlighted by the
participants is its focus on the health and health awareness
of pregnant women. In this regard, Participant No. 11 who
was a pediatrician stated, “Zhian health organization has a
significant focus on pregnant women’s health because we
believe that healthy and health-aware pregnant mothers
give birth to healthy children. And I think we have been
quite successful in this regard.” Focus on self-care among
pregnant women was also mentioned by Participant No. 3
who was a doctor by saying, “We pay pregnant women
regular visits tent to tent in the camp. During our visits we
teach them about healthy diets, good exercises, suitable
lifestyle, and negative effects of some bad habits. The
pregnant women in the camp are well aware of their
health.” Also, Participant No. 6 who was a pregnant
woman said, “They give us regular check-ups and provide
us with useful health information which is useful for me
and my baby.”
Third subtheme: Raising the women’s awareness of
gender-based violence
Zhian Healthcare Organization has a center which provides
specific services regarding gender-based violence (GBV)
which is called GBV Center. The goal of this center is raise
women’s awareness of GBV and prevent this phenomenon.
In this regard, Participant No. 2 who was the manager of
GBV center stated, “Due to the specific culture structure of
our community, there is a high rate of GBV. In this regard,
our center aims to raise women’s awareness of this
phenomenon and how to prevent it by giving them regular
educational classes.” Also, Participant No. 1 who was a
social researcher mentioned, “We have been able to protect
females against GBV by consulting them and training them
on a regular basis. Now, the women know about the bad
effects of childhood marriage as the main risk factor for
GBV.” Moreover, Participant No. 12 stated, “As a
tradition, girls are forced to marry early, even at the age of
9 years. However, they have taught us about the bad effects
of childhood marriage, so we avoid it.”
Second main theme: Providing emergency health care
The second main theme that emerged out of data analysis
was a justification for one of the main goals of Zhian
health organization which is providing health care in
emergency situations. In this regard, Participant No. 16
revealed, “In Zhian health organization, we are always
ready to provide quality health service to the camp
residents in emergency situations. These services are
provided 7/24. Our clinics are always open and ready to
admit patients with emergency needs.” Moreover,
Participant No.14 stated, “They have helped us in most
emergency situations, particularly when there is a
pregnant woman, they take good care of her and her baby.
And I can say that we have access to healthcare services
that are available in Erbil, which is thanks to Zhian health
organization.” This theme had two subthemes which are
presented below.
First subtheme: Providing refugees with emergency
health care
As indicated by data analysis, Zhian health organization
has been successful in providing emergency healthcare
services to refugees, particularly those who have been
displaced from Syrian. In this regard, Participant No. 7
who was a doctor stated, “This camp includes a large
number of Syrian refugees. When the refugees arrive in the
camp for the first time, most of them are not at a good
health status. However, after staying here for a few months
and receiving necessary healthcare services, they will be in
a better health status.” Also, Participant No. 15 who was a
Syrian Refugee said, “As a result of emergency health
services provided by Zhian health organization, we can
receive require health care almost all the time during the
day and night.”
Second subtheme: Providing internally displaced persons
with emergency health care
Data analysis also showed that Zhian health organization
has successfully delivered healthcare services to internally
displaced persons (IDPs). In this regard, Participant No. 4
mentioned, “Most of the residents in the camp are Arabs
who are displaced from other cities and town of Iraq. They
are provided with healthcare services in emergency
situations, and they can refer to the clinic at any time
during the day or night. In addition, we visit the patients in
their tents whenever there is an emergency situation or
when the patient cannot be taken to the clinic.” Also,
Participant No. 13 stated, “Due to 7/24 provision of
healthcare services by Zhian health organizationin the
camp, our health status has improved compared to before
coming to and living in the camp.”
IV. DISCUSSION
The present study was aimed at investigating the role of
Zhian health organization which is an active primary
healthcare organization in Erbil, Iraqi Kurdistan in
activating self-care practices and responding to emergency
situations in the region of its activity. For this purpose,

ISSN: 2456-8015
several unstructured in-depth interviews were carried out
with some doctors, nurses, and employees working in the
organization and some patients who had received
healthcare services from the organization. The results
revealed that the organization has been successful in
promoting healthcare awareness among the residents of the
camps, leading to promotion of self-care practices. It has
also been successful in responding to emergency situations,
especially in the case of pregnant women.
The first theme that emerged in this study was raising
health awareness among the clients who are refugees and
IDPs. This finding is in good agreement with the results of
the study carried out by Ejaz et al. (2011) who concluded
that NGOs have a relatively better performance in terms of
both delivery of healthcare services and awareness raising,
which is distributed by them to the fact that NGOs have
more flexible planning and are able to design population
based projects aimed at education and promotion of health
[17]. As revealed by the results of the present study, Zhian
health organizationhas successfully raised public
awareness of health issues. Similar to this finding, Smith et
al. (2001) also pointed out that private sector in the form of
healthcare NGOs provide better healthcare services
compared to the public sectors because strategy planning
and flexibility are two key attributes of the private sector;
therefore, they can perform better with regard to raising
public awareness of health care [18]. Anbazhagan and
Surekha (2016) even extended the activity and effect scope
of NGOs and stated that such organizations can even raise
international awareness of healthcare issues provided that
they are cooperated by related governmental institutions
and entities [19].
As stated by the participants in the present study, Zhian
health organization has been successful in raising the
pregnant women’s awareness of healthcare issues, whereby
their self-care practices have been enhanced. In line with
this finding, Mercer et al. (2004) reported that in areas
where healthcare NGOs are active, the rate of deaths as a
result of the stillbirths and neonatal mortality is relatively
lower than other areas. They further related this fact to the
active role of such NGOs in delivering maternal healthcare
services and raising pregnant women’s awareness of
maternal health [20]. In their study, George et al. (2018)
highlighted this point that if the community is supported by
health NGOs, there will be remarkable improvement in
maternal health, healthcare awareness, and self-care
practices [21].
Due to existence of a gender-based violence center in
Zhian health organization, one of its major aims is to
reduce the rate of gender-based violence (GBV) among its
clients. In this regard, as revealed by the participants, the
women are taught about risk factors for GBV, among
which they specifically referred to childhood marriage.
Therefore, another subtheme of the present study was the
success of Zhian health organization in raising the
women’s awareness of GBV. This finding is in line with
the reports of the World Health Organization (2010) that
stated that violence against women needs to be monitored
and can be reduced as a result of cooperation of
administrative and healthcare workers in the form of
healthcare NGOs [22]. This finding is also in line with
those of the study carried out by Glass et al. (2018) who
referred to the significant role of healthcare NGOs in
raising the community’s awareness of GBV and decreasing
its prevalence rate [23].
The results also revealed the successful role of Zhian
health organization in providing healthcare services in
emergency situations. This finding is in agreement with
those of the study carried out by Yagub and Mtshali (2015)
who stated that healthcare non-governmental organizations
had a successful performance with regard to providing
healthcare services in emergency situations [24]. Similar
findings were reported by Mercer et al. (2004) who
highlighted the role of such NGOs in delivering quick and
quality health care in emergency situations [20]. The
participants revealed the successful performance of Zhian
health organizationin providing emergency health care to
refugees and IDPs. The remarkable role of NGOs in
providing emergency health care to refugees has been
emphasized by Spiegel et al. (2018) [25] and to IDPs by
Hakamies et al. (2008) [26].
V. CONCLUSION
As an active healthcare NGO in the Kurdistan Region of
Iraq, Zhian health organization Primary Healthcare
Organization has performed successfully in raising
awareness of health care among the public and particularly
among pregnant women, which has led to a remarkable
increase in their self-care practices. It has also been
successful in providing healthcare services to refugees and
IDPs in emergency situations. Therefore, the Ministry of
Health and the government are recommended to encourage
development of such organizations in order develop and
implement an efficient self-care system in the region and
come up with a healthier community.

ISSN: 2456-8015
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